Oudshoorn Abe, Sangster Bouck Michelle, McCann Melissa, Zendo Shamiram, Berman Helene, Banninga Jordan, Le Ber Marlene Janzen, Zendo Zayya
Western University, London, Canada.
Middlesex-London Health Unit, London, Canada.
Harm Reduct J. 2021 Jan 6;18(1):6. doi: 10.1186/s12954-020-00458-0.
Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs.
A critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. Sixteen participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants.
A key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or "chapters": Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes: one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations.
This study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users' sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.
在全球范围内，社区在争取对为应对药物使用影响而实施的减少伤害策略的支持方面面临困难。这一讨论的一个关键部分是理解吸毒者并让他们参与进来，以帮助制定社区减少伤害策略。本研究聚焦于过量用药预防点如何影响吸毒者的生活。
采用了以照片叙事为核心的批判性叙事方法。招募了27名前往过量用药预防点的人员参与初步访谈。随后，16名参与者拍摄照片以描述该预防点的影响，并参与第二轮访谈。通过独立编码和多轮团队分析，提出了四个主题，构成了一个核心叙事，涵盖了参与者的多样经历。
参与者共同传达的一个关键信息是，自进入该预防点以来，他们感觉自己的生活有所改善。所提出的核心叙事呈现为一系列四个主题或“章节”：忍耐、获得安全、建立联系与归属感以及转变。这些章节遵循一系列转变，展现了参与者通过自己的视角所呈现的一段旅程：从彻底绝望走向希望、机会和包容。一开始，参与者只是试图在混乱的药物使用挑战中求生，而通过该预防点提供的关系和服务，他们走向了或大或小的生活转变。
本研究有助于更深入地理解与过量用药预防点工作人员的关怀关系如何影响预防点使用者的自我认知。我们提出，关怀关系本身就是一种干预，并且这些关系促成的转变远远超出了减少疾病这一公共卫生成果。该预防点的关怀关系可以成为重大社会变革的起点。然而，为了实现真正的变革，该预防点内部存在的微观环境需要延伸到其围墙之外。吸毒者在这些预防点之外所经历的边缘化和污名化仍然是他们生活实现稳定的持续障碍。
